NICE guidance on giving birth – a positive change or cause for alarm?

There has been a flurry of media stories about the updated guidelines from the National Institute for Health and Care Excellence (NICE) about the care of healthy women and their babies during childbirth.

The stories have focused on the recommendation that women should be encouraged to give birth at home. But what do the guidelines really say?

They’re actually pretty reasonable. They say that women who have already given birth once, and who are low-risk, should be told that giving birth either at home or in a midwifery unit is particularly suitable for them, because “the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit.”

For women who are having their first baby and are low-risk, the guidelines say they should be advised that “planning to give birth in a midwifery‑led unit (freestanding or alongside) is particularly suitable for them because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit.”

In other words, if you’re having your first baby, it’s probably better not to give birth at home. But giving birth in a midwife-led unit will, on balance, be a better experience than giving birth in hospital.

For high-risk women, the advice will be different. But the move away from the historical insistence that most women should give birth in hospitals because it’s “safer” is to be welcomed – as long as it doesn’t mean that women who want to give birth in hospital are now pressured to give birth at home or in a midwife-led unit. It’s easy for one dogma to be replaced by another.

I also liked this sentence, which wasn’t there in the 2007 guidelines:

“Providers, senior staff and all healthcare professionals should ensure that in all birth settings there is a culture of respect for each woman as an individual undergoing a significant and emotionally intense life experience, so that the woman is in control, is listened to and is cared for with compassion, and that appropriate informed consent is sought.”

It’s sad that it needs to be said at all. But I wish that that sentence had been the headline news: perhaps if all women knew that they were going to be treated with respect and compassion during labour, the decision about where to give birth would become much less important.

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